Abstract

Background: An organized stroke system of care includes the development of Primary Stroke Centers (PSCs) and preferential emergency medical services (EMS) routing to deliver suspected stroke patients to designated PSCs. EMS routing of stroke patients is not nationally governed and in California, EMS routing is decided on the county level. EMS routing policies might provide a financial or competitive incentive for hospitals to invest in PSC accreditation. We sought to evaluate the relationship between the independent adoption of EMS stroke routing protocols and hospital acquisition of PSC designation in California.

Methods: All dates of California PSC certification were obtained through The Joint Commissions website qualitycheck.org and follow-up call to the stroke coordinator. Starting dates of EMS stroke routing policies were obtained for each county with at least one PSC. We describe the number of hospitals achieving PSCs designation relative to implementation of EMS routing policies, and annual rates of conversion to PSC for each county.

Results: As of June 2012 there are 127 PSCs in California in 27 counties; 22 of 58 counties have implemented EMS routing policies. The greatest number of PSCs were in Los Angeles County (29) followed by San Diego (11) and Santa Clara (9) counties. Achievement of PSC designation was more frequent in the periods immediately before and after a county’s adoption of EMS routing (48 PSCs,38% of total, designated within one year and 81,64%, within 2 years). In Los Angeles, there were 4 hospitals with PSC certification >1 year in advance of EMS routing, 11 within a year of EMS routing and 13 additional PSC’s >1 year after EMS routing policies. The rate of conversion to stroke center accelerated prior to EMS diversion policy adoption and decelerated in the years following.

Conclusion: Implementation of EMS routing policies may be an important factor driving PSC certification. National adoption of EMS routing policies for stroke may lead to greater numbers of PSCs, which could positively impact patient care.